Clin Nutr Res.  2017 Jul;6(3):221-228. 10.7762/cnr.2017.6.3.221.

Intensive Nutrition Management in a Patient with Short Bowel Syndrome Who Underwent Bariatric Surgery

• Kweon M
• Ju DL
• Park M
• Choe J
• Suh YS
• Seol EM
• Lee HJ

• KMID: 2385627
• DOI: http://doi.org/10.7762/cnr.2017.6.3.221

Abstract

Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due to morbid obesity in Jan 2013 at a certain hospital and successfully reduced her weight from 110 kg to 68 kg. However, after a delivery of the second baby by cesarean section in Jul 2016, most of small bowel was herniated through Peterson's defect, and emergent massive small bowel resection was performed. Thereafter, she visited our hospital for the purpose of intestinal reconstruction. In Sep 2016, she received side-to-side gastrogastrostomy and revision of double barrel enterostomy. The remaining small bowel included whole duodenum, 30 cm of proximal jejunum, and 10 cm of terminal ileum. Pylorus and ileocecal valves were intact. The patient given only PN after surgery was provided rice-based soft fluid diet after 10 day of operation. Through intensive nutritional management care, she could start solid meals, and finally stop the PN and eat only orally at 45 days postoperatively. Three nutritional interventions were conducted over 2 months after the patient was discharged. She did not require PN during this period, and maintained her weight within the normal weight range. Similar interventions could be used for other patients with malabsorption problems similar to SBS.

Keyword

Short bowel syndrome; Intensive nutritional management; Oral intake

MeSH Terms

Bariatric Surgery*
Cesarean Section
Diet
Duodenum
Enterostomy
Female
Gastric Bypass
Humans
Ileocecal Valve
Ileum
Jejunum
Meals
Nutritional Status
Nutritional Support
Obesity, Morbid
Parenteral Nutrition
Pregnancy
Pylorus
Seoul
Short Bowel Syndrome*

Figure

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  Figure 1 Change in intake by route for (A) energy and (B) protein. POD, postoperative day; PN, parenteral nutrition.

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  Figure 2 The patient's weight over the course of the intervention. POD,postoperative day; BMI, body mass index (kg/m2).

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